Clinical study
Predictors of Successful Palliation of Compression Fractures with Vertebral Augmentation: Single-center Experience of 525 Cases

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Purpose

To determine the effectiveness of vertebral augmentation in relieving pain, differences in pain relief outcomes based on procedure type were investigated. Variables that potentially influence outcomes were identified.

Materials and Methods

A database of 525 cases (740 levels) treated for compression fractures with vertebroplasty, kyphoplasty, or S1-level sacroplasty was compiled. Average age was 75 years ± 12, and 72.4% of patients were female. Variables evaluated included age, sex, fracture etiology, procedure type, vertebral level treated, number of levels treated per procedure, and technical approach. Outcomes were assessed by a binary system of “responders” (ie, patients with improvement/resolution of pain) versus “non-responders” (ie, those with no change/worsening of pain) and with a four-level pain scale (1, pain resolution; 2, pain improvement; 3, no change; 4, worse pain) retrospectively applied from medical records. Univariate and multivariate analyses determined outcomes.

Results

Four-hundred and sixty-seven patients (89%) showed a response to treatment: 40% had pain resolution and 49% had pain improvement. Multivariate analysis showed that women and older patients had greater odds of being responders (odds ratios [ORs], 0.56 and 0.98, respectively; P = .016 and P = .048, respectively). Patients without cancer (OR, 1.60; P = .012) and women (OR, 2.05; P = .0002) were more likely to experience pain resolution. Increasing numbers of levels treated per case were associated with decreased odds of pain resolution (OR, 0.69; P = .0081). Sex and number of levels treated were independently predictive of pain scale outcomes (ORs, 2.0 and 0.71, respectively; P = .0003 and P = .015).

Conclusions

Vertebral augmentation procedures provide pain relief for a majority of patients regardless of underlying fracture etiology. There was no difference in pain outcomes among procedure types. Age and sex may be predictive of pain outcomes.

Section snippets

Data Collection

We performed an institutional review board–approved retrospective analysis of 613 patients consecutively treated at our institution with vertebroplasty, kyphoplasty, or sacroplasty procedures for compression fractures between May 2003 and March 2008. We attempted to be as comprehensive and exhaustive as possible in our identification of the population treated: patients were identified through an electronic database search of the terms “vertebroplasty,” “kyphoplasty,” “embolization,” or the

Results

Of 525 cases, 467 (89%) were classified as responders: 210 (40%) had complete pain resolution and 257 (49%) reported improvement in pain. In 42 cases, 8% reported no change in their pain and 16 (3%) reported worsening in pain after the procedure. A large majority of patients (>90%) were followed up within 6 months of their procedure (Table 2).

In the 525 cases, 740 levels were treated (Fig 1). Consistent with previously reported data (2, 31), most compression fractures occurred at the

Discussion

This study evaluated pain outcomes in patients treated with vertebroplasty, kyphoplasty, or S1-level sacroplasty for vertebral compression fractures of all causes. Outcomes were determined by a dichotomized responder-versus-nonresponder system and further classified in a four-level pain scale based on a retrospective review of medical records. Most patients in this study were between 70 and 89 years of age at the time of their procedure, and a majority were women. Osteoporosis was the most

Acknowledgment

The authors thank Elkan Halpern, PhD, for all of his assistance with the statistical analyses.

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    J.A.H. is a consultant for and minor shareholder in Cardinal Health (Dublin, Ohio) and Medtronic (Minneapolis, Minnesota). None of the other authors have identified a conflict of interest.

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